What Is a Pleural Biopsy?

Three types of pleural biopsies are needle biopsy, thoracoscopic biopsy, and open biopsy.

A pleural biopsy is a procedure used to remove a sample of the pleura using a special biopsy needle during surgery to diagnose disease, infection or cancer.

Pleura is a thin tissue that lines the chest cavity and surrounds the lung. A biopsy is a procedure to remove a sample of tissues or cells from the body so that it can be analyzed in a lab. Pleural biopsy is performed to diagnose various lung problems.

There are three types of pleural biopsies:

Needle biopsy: This is done under local anesthesia, the physician inserts the special biopsy needle into the pleural space (the space between the pleura and the chest wall) to obtain a sample. Ultrasound (high-frequency sound waves) or computed tomography (CT scan, a combination of X-ray and computer technology) may be used to guide the biopsy needle insertion. Most pleural biopsies are performed using this technique. This procedure may also be referred to as a thoracentesis.

Thoracoscopic biopsy: A special type of endoscope (thin, flexible, lighted tube) is inserted into the pleural space under either local or general anesthesia. The endoscope help physician visualizes the pleural tissue and takes a biopsy of any suspicious site.

Open biopsy: This done under general anesthesia, the physician makes an incision in the skin and surgically removes a piece of the pleura. Depending on the laboratory findings, further surgery may be performed.

Pleural biopsy is performed to:

• Evaluate an abnormality of the pleura seen on chest x-ray
• Diagnose the cause of recurrent pleural infection (caused by bacteria, virus, fungus, or tuberculosis) or other condition
• Investigate fluid collection in the pleural space (pleural effusion)
• Determine if a pleural mass is malignant (cancerous) or benign
• Obtain further information after pleural fluid analysis suggests the presence of cancer, infection or tuberculosis

A pleural biopsy may be performed on an outpatient basis or a part of the hospital stay. Procedures may vary depending on the patient’s condition.

• The patient’s vital signs (heart rate, blood pressure, breathing rate, and oxygen level) may be monitored before and during the procedure.
• Patients may receive supplemental oxygen as needed, through a face mask or nasal cannula (tube).
• The patient will be placed in a sitting position with arms raised and resting on an overbed table. This position aids in spreading out the spaces between the ribs for needle insertion. If a patient is unable to sit, they may lie on their sides on the edge of the bed on the unaffected side.
• The patient will be asked to hold still, exhale deeply, and breathe during the procedure.
• The skin at the puncture site will be cleansed with an antiseptic solution.
• The patient will receive a local anesthetic. They may experience a brief stinging sensation at the site of the injection.
• When the area is numb, the physician will insert a needle between the ribs in the back. The patient may experience some pressure at the injection site.
• When the needle enters the pleural space, fluid may be withdrawn slowly.
• The physician will insert the biopsy needle into the site. One or more samples of pleural tissue will be obtained.
• The biopsy needle will be withdrawn and firm pressure will be applied to the biopsy site for a few minutes until any bleeding has stopped.
• A sterile adhesive bandage/dressing will be applied.
• The tissue sample will be sent to the lab for examination.
• The patient may have a chest X-ray immediately after the biopsy.

As with any surgical procedure, complications may occur. Possible complications of a pleural biopsy may include:

• Air becomes trapped in the pleural space causing the lung to collapse (pneumothorax)
• Bleeding in the lung
• Infection
• Pain
• Anesthesia-related complications like headache and drowsiness.

Pleural biopsy is not indicated in certain bleeding conditions and pregnant patients.